Monday, February 8, 2010

Interesting reading

I got a letter in the mail today. It was a copy of the letter that old Dr. GI wrote to my insurance company to appeal their decision to decline payment for the Sandostatin drug he wanted me to take. See, I actually haven't let old Dr. GI know that I saw new Dr. GI, so technically at the moment, I have two doctors. I pay for them so they shouldn't get mad - right?

In case you don't really want to read all my past blog posts this letter sums up the last year quite nicely. Allow me to share some excerpts. (And you thought I made all this stuff up - snicker)

Ms. Schaeffer is a complicated patient who has know Crohn's disease involving the small intestine. This was initially diagnosed at laparotomy requiring a resection of the small bowel. She has a history of colon polyps, diverticulosis, and gastroesophageal reflux disease. She has had her gall bladder removed. For more than one year she has been suffering with severe diarrhea. A rather extensive evaluation has been required. This has included an essentially normal colonoscopy, a normal upper endoscopy, and negative small bowel evaluation. The latter has included biopsies of the small bowel looking for sprue as well as a balloon endoscopy to rule out active Crohn's disease. Her diarrhea has failed to be controlled with Questran and Entocort. Attempts to symptomatically control her with Imodium have been unsuccessful.

Ms. Schaeffer has had stool collections which have revealed documented steatorrhea. She has been given various pancreatic enzyme treatments for the presumed diagnosis of pancreatic insufficiency. She has had unusual and sever reactions to these, which have precluded their use. An ERCP examination was done on 12/22/09. This was done to evaluate extreme abdominal pain that she was having in conjunction with her diarrhea. Elevations of lipase had been noted, although liver enzymes had been normal. This examination revealed stenosing papillitis with common bile duct debris. A sphincterotomy was carried out and the duct was cleaned. A normal ventral pancreatic duct was noted. A diagnosis of pancreas divisum was made, and a pancreatogram of the dorsal pancreatic duct was not obtained. A previous MRI done in July 2009 had been normal.

... It is my opinion that this represents chronic pancreatitis involving the dorsal pancreatic duct. The problem has been significantly complicated by her inability to tolerate a number of different pancreatic enzymes.

The letter basically goes on to say that he feels the Sandostatin would help my pain and changes to my diet may be necessary. I found it very interesting to read his medical opinion of what has been going on with me. This may take some thinking to determine how I feel about it. Opinions?

1 comment:

BrightSide said...

Whew! You are indeed a complicated patient! My gut reaction to the letter is that your doctor has been giving you all the tests he can think of and is doing his best- but your condition whatever it is seems to be quite tricky and hard to pin down.

I'm totally behind your decision to try another doctor - more eyes and second opinions are always a good idea.... but it doesn't sound like the first doctor was slacking off or anything. Maybe you could tell him about your second GI so that he could send your test results to the new doctor - so he has all that good information at his disposal too?